Magnan A, Ottomani A, Garbe L, Arnaud A, Manelli J C
Service de Pneumologie, Hôpital Nord, Marseille.
Ann Fr Anesth Reanim. 1991;10(1):74-6. doi: 10.1016/s0750-7658(05)80273-4.
A 31-year-old woman, heroin addict since ten years, and infected by the human immunodeficiency virus (HIV) since one year, was admitted to the intensive care unit for respiratory failure (PaO2 = 40 mmHg and PaCO2 = 14.8 mmHg, despite breathing pure oxygen). She had been followed up for 6 months for increasing dyspnoea due to chronic cor pulmonale for which no satisfactory explanation had been put forward. Artificial ventilation with 8 cmH2O positive end-expiratory pressure and 100% oxygen was completely inefficient. She died within a few hours. Postmortem lung biopsy revealed talc particles within interalveolar walls and alveolar macrophages as well as the expected alterations in blood vessels. Pulmonary hypertension due to talc microemboli is a well-known cause of respiratory failure in heroin addicts. Such a diagnosis should not be overlooked in a patient infected with HIV. Respiratory failure may not be only due to opportunist infections, or tumours related to the HIV infection.
一名31岁女性，有十年海洛因成瘾史，感染人类免疫缺陷病毒（HIV）一年，因呼吸衰竭（尽管吸入纯氧，动脉血氧分压（PaO2）= 40 mmHg，动脉血二氧化碳分压（PaCO2）= 14.8 mmHg）入住重症监护病房。她因慢性肺源性心脏病导致呼吸困难加重已随访6个月，但对此未给出令人满意的解释。采用8 cmH2O呼气末正压和100%氧气进行人工通气完全无效。她在数小时内死亡。尸检肺活检显示肺泡间隔和肺泡巨噬细胞内有滑石颗粒，以及血管的预期改变。滑石微栓塞导致的肺动脉高压是海洛因成瘾者呼吸衰竭的一个众所周知的原因。在感染HIV的患者中不应忽视这样的诊断。呼吸衰竭可能不仅仅是由于机会性感染或与HIV感染相关的肿瘤。
